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Ann Thorac Surg 1987;44:370-378
© 1987 The Society of Thoracic Surgeons

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Articles

Operation for Hypertrophic Subaortic Stenosis in the Aged

From the Surgery and Cardiology Branches, National Heart, Lung, and Blood Institute, Bethesda, MD

Accepted for publication March 13, 1987.

^* Address reprint requests to Dr. Cooper, National Institutes of Health, Surgery Branch, NHLBI, Building 10, Room 2N244, Bethesda, MD 20892

To determine if operative palliation of idiopathic hypertrophic subaortic stenosis (IHSS) is worthwhile in the elderly, hemodynamic, cardiac conduction, symptomatological, functional, and survival data were examined in 52 patients (39 women) 65 years old and older (mean age, 69 years; range, 65 to 81 years) who had a left ventricular myotomy and myectomy (LVMM) (Morrow procedure) alone or with concomitant operations. Seventy-four percent of all operative survivors underwent catheterization an average of 6 months postoperatively. The mean follow-up was 54 months (range, 5 to 120 months). The population was divided for analyses into those with coronary artery disease (CAD) (N = 11, 21%) and those without (N = 41). The peak resting left ventricular outflow tract gradient was reduced from 65 ± 16 mm Hg to 3 ± 1 mm Hg (p < 0.01) in the group with CAD and from 95 ± 13 mm Hg to 17 ± 9 mm Hg (p < 0.001) in the group without CAD. Significant reductions in peak gradients in response to provocation also occurred in both groups. New conduction abnormalities occurred in 72% of survivors, 85% of whom showed improvement in regard to symptoms. The overall average New York Heart Association Functional Class was 3.2 ± 0.1 preoperatively and at latest follow-up, 1.9 ± 0.1 (p < 0.001). The hospital mortality for LVMM alone in the absence of CAD was 8% with a 5-year actuarial survival of 75 ± 8%. LVMM in the presence of CAD resulted in an operative mortality of 27% (N = 3); all deaths were related to an acquired ventricular septal defect. The total surgical mortality was 17% (N = 9). Operative palliation of the elderly with IHSS can, therefore, be performed with marked hemodynamic and symptomatic improvement and long-term survival at improved functional levels.

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